DISCLOSURE STATEMENT
In accordance with the provisions of Section 604(b) (2) (A) of the Fair Credit Reporting Act, Public Law 91-508, as amended by the Consumer Credit Reporting Act of 1996 (Title II, Subtitle D, Chapter I, of Public Law 104-208), you are being informed that reports verifying your previous employment, previous drug and alcohol test results, and your driving record may be obtained on you for employment purposes. These reports are required by Sections382.413, 391.23, and 391.25 of the Federal Motor Carrier Safety Regulations. The Company may request background information about you from a consumer reporting agency in connection with your employment application and for employment purposes. This information may be obtained in the form of consumer reports and/or investigative consumer reports. These reports may be obtained at any time after receipt of your authorization and, if you are hired by the Company, throughout your employment.
Asurint or another consumer reporting agency will obtain the reports for the company. The reports may contain information bearing on your character, general reputation, personal characteristics, mode of living and credit standing. The types of information that may be obtained include, but are not limited to: social security number verifications; credit reports; criminal records checks; public court records checks; driving records checks; educational records check; employment verifications; personal and professional references check; licensing and certification records checks; drug testing result; etc. The information contained in the reports will be obtained from private and public record sources, including, as appropriate, personal interviews with sources, such as neighbors, friends and associates.
You may request more information about the nature and scope of any investigative consumer reports by contacting the Company. A summary of your rights under the Fair Credit Reporting Act is also being provided to you.
AUTHORIZATION TO RELEASE INFORMATION
I am a serious applicant for employment at . As such, I certify that the information I have provided to the Company is accurate and complete. I authorize the Company and any agent acting on its behalf to confirm this information and to secure necessary information from all my employers. As part of this inquiry, my complete police and driving record will be reviewed as well as any information pertaining to prior drug and alcohol testing performed by past employers. I release all of those information providers, the Company and any agent acting on its behalf from any and all liability arising from their giving or receiving information about my employment history, previous drug and alcohol test results or qualifications.
I understand that, as an applicant for a position with the Company, I may be asked to demonstrate that I am capable of performing tasks which are pertinent to the job. I also understand that if offered a job, it may be conditioned on the results of a physical examination and drug test. I understand that this information is confidential and that disclosure of this information to me and to others will be governed by company policy and state law. This authorization will remain in effect throughout the term of employment. Any false or misleading statements I have made will be sufficient cause for rejection of my application or for dismissal if the company employs me.
IMPORTANT NOTICE TO DRIVERS REGARDING BACKGROUND REPORTS In connection with your application for employment by mail, telephone, fax, or computer, and during employment should you be offered a position, the Company ("Prospective Employer") may obtain one or more reports regarding your employment, credit, driving, and/or criminal background history from a Consumer reporting agency and/or other sources. If the Prospective Employer uses any information it obtains from a background report by a consumer reporting agency in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer will notify you that the action has been taken and that the action was based in part or in whole on the background report, and will inform you about how to get in touch with the consumer reporting agency and obtain a free copy of the background report, and about your right to dispute any incomplete or inaccurate information in the report.
The Prospective Employer cannot obtain background reports from consumer reporting agencies or other sources regarding you unless you consent in writing. If you agree that the Prospective Employer may obtain such background reports, please read and sign the authorization form.
